The administration has been pushing very hard on the Accountable Care Organization (ACO) model, which is a somewhat nebulous concept, but which is broadly supposed to save money by streamlining services and coordinating care. It's one of the centerpieces that pro-Obamacare wonks point to as a real source of cost savings and improved services. Exhibits A and B are usually Mayo and the Cleveland Clinic, with a few others occasionally thrown in.

However, when the administration rolled out its new ACO program last March, the poster children declined to participate, and an organization that represents large provider groups sent a letter to the Center for Medicare and Medicaid Services indicating that most of their members would not participate. The reporting requirements, and the financial penalties for ACOs that didn't achieve savings, were simply too onerous.

During the health care debate, the Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare were repeatedly touted as models for a new health care delivery system.

Now, they have something else in common: All four have declined to apply for the "Pioneer" program tailor-made by the Obama administration to reward such organizations.

"When the poster boys ask that the posters be taken down, you have a problem," says Michael Millenson, president of Health Quality Advisors LLC. The lack of participation, he says, suggests that "somebody messed up": either the government didn't make the rules appealing enough, or "when push came to shove, the big players didn't want to play by the rules."

The four health systems are considered the most promising models for "accountable care organizations," a new approach to delivering health care services that rewards doctors and hospitals for providing high-quality care to Medicare beneficiaries while keeping costs down. The ACO provision became one of the most highly anticipated elements of the health care overhaul, and providers embarked on a frenzied race to join in as quickly as possible.

ACOs--or at least some of the features that the administration envisions--may well be the future of Medicare, for all I know. But it was always folly to point to places like the Mayo Clinic as an example of what was possible for national health care reform.

Mayo is the best in the world at what it does. This allows it to give all sorts of rewards to doctors that compensate for not being richly remunerated gunslingers: the status of working at Mayo, the excitement of being near the cutting edge, the reward of working with other tip-top physicians. You can no more replicate that nationwide than you could turn every college in America into Harvard. Hell, you could build a scale replica of Harvard, put every last one of its rules and policies into effect at your new school, and hire Harvard-trained anthropologists to observe how people at Harvard act, and teach people at the new school to behave the same way. You could put into place an elaborate system of incentives designed to reward people who act like Harvard people, and punish those that don't. And at the end of the day, it still wouldn't be Harvard. It probably wouldn't even be a second-tier state school. It would be expensive performance art.

There's a clue to this in the fact that the top models for ACOs don't want to join the program. Doing so would kill the autonomy and flexibility that makes the institution great--and that standardization would rob the institution of the status that lets it attract top talent. It's also possible that they don't think that threats would make their doctors better at their jobs.

I've written before about the difficulty of replicating successful small-scale programs into large-scale transformation of the health care system. It continues to be very difficult.

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Congressional Republicans and conservative pundits had the chance to signal Trump his attacks on law enforcement are unacceptable—but they sent the opposite message.

President Trump raged at his TV on Sunday morning. And yet on balance, he had a pretty good weekend. He got a measure of revenge upon the hated FBI, firing former Deputy Director Andrew McCabe two days before his pension vested. He successfully coerced his balky attorney general, Jeff Sessions, into speeding up the FBI’s processes to enable the firing before McCabe’s retirement date.

Beyond this vindictive fun for the president, he achieved something politically important. The Trump administration is offering a not very convincing story about the McCabe firing. It is insisting that the decision was taken internally by the Department of Justice, and that the president’s repeated and emphatic demands—public and private—had nothing whatsoever to do with it.

The first female speaker of the House has become the most effec­tive congressional leader of modern times—and, not coinciden­tally, the most vilified.

Last May, TheWashington Post’s James Hohmann noted “an uncovered dynamic” that helped explain the GOP’s failure to repeal Obamacare. Three current Democratic House members had opposed the Affordable Care Act when it first passed. Twelve Democratic House members represent districts that Donald Trump won. Yet none voted for repeal. The “uncovered dynamic,” Hohmann suggested, was Nancy Pelosi’s skill at keeping her party in line.

She’s been keeping it in line for more than a decade. In 2005, George W. Bush launched his second presidential term with an aggressive push to partially privatize Social Security. For nine months, Republicans demanded that Democrats admit the retirement system was in crisis and offer their own program to change it. Pelosi refused. Democratic members of Congress hosted more than 1,000 town-hall meetings to rally opposition to privatization. That fall, Republicans backed down, and Bush’s second term never recovered.

Invented centuries ago in France, the bidet has never taken off in the States. That might be changing.

“It’s been completely Americanized!” my host declares proudly. “The bidet is gone!” In my time as a travel editor, this scenario has become common when touring improvements to hotels and resorts around the world. My heart sinks when I hear it. To me, this doesn’t feel like progress, but prejudice.

Americans seem especially baffled by these basins. Even seasoned American travelers are unsure of their purpose: One globe-trotter asked me, “Why do the bathrooms in this hotel have both toilets and urinals?” And even if they understand the bidet’s function, Americans often fail to see its appeal. Attempts to popularize the bidet in the United States have failed before, but recent efforts continue—and perhaps they might even succeed in bringing this Old World device to new backsides.

As the Trump presidency approaches a troubling tipping point, it’s time to find the right term for what’s happening to democracy.

Here is something that, even on its own, is astonishing: The president of the United States demanded the firing of the former FBI deputy director, a career civil servant, after tormenting him both publicly and privately—and it worked.

The American public still doesn’t know in any detail what Andrew McCabe, who was dismissed late Friday night, is supposed to have done. But citizens can see exactly what Donald Trump did to McCabe. And the president’s actions are corroding the independence that a healthy constitutional democracy needs in its law enforcement and intelligence apparatus.

McCabe’s firing is part of a pattern. It follows the summary removal of the previous FBI director and comes amid Trump’s repeated threats to fire the attorney general, the deputy attorney, and the special counsel who is investigating him and his associates. McCabe’s ouster unfolded against a chaotic political backdrop which includes Trump’s repeated calls for investigations of his political opponents, demands of loyalty from senior law enforcement officials, and declarations that the job of those officials is to protect him from investigation.

How evangelicals, once culturally confident, became an anxious minority seeking political protection from the least traditionally religious president in living memory

One of the most extraordinary things about our current politics—really, one of the most extraordinary developments of recent political history—is the loyal adherence of religious conservatives to Donald Trump. The president won four-fifths of the votes of white evangelical Christians. This was a higher level of support than either Ronald Reagan or George W. Bush, an outspoken evangelical himself, ever received.

Trump’s background and beliefs could hardly be more incompatible with traditional Christian models of life and leadership. Trump’s past political stances (he once supported the right to partial-birth abortion), his character (he has bragged about sexually assaulting women), and even his language (he introduced the words pussy and shithole into presidential discourse) would more naturally lead religious conservatives toward exorcism than alliance. This is a man who has cruelly publicized his infidelities, made disturbing sexual comments about his elder daughter, and boasted about the size of his penis on the debate stage. His lawyer reportedly arranged a $130,000 payment to a porn star to dissuade her from disclosing an alleged affair. Yet religious conservatives who once blanched at PG-13 public standards now yawn at such NC-17 maneuvers. We are a long way from The Book of Virtues.

Much more than time separates the 27th president from the 45th: from their vastly different views on economics, to their conceptions of the presidency itself.

As Donald Trump’s executive orders punishing steel and aluminum imports threaten a trade war around the globe, Republicans on Capitol Hill are debating whether to reassert Congress’s ultimate constitutional authority over tariffs and trade. This isn’t the first time the GOP has split itself in two on the question of protective tariffs. But the last time, just over 100 years ago, the Republican president’s policies were the exact opposite of Trump’s.

William Howard Taft—in his opposition to populism and protectionism, as well as his devotion to constitutional limits on the powers of the presidency—was essentially the anti-Trump. Unlike the current president, and his own predecessor, Theodore Roosevelt, Taft refused to rule by executive order, insisting that the chief executive could only exercise those powers that the Constitution explicitly authorizes.

Among the more practical advice that can be offered to international travelers is wisdom of the bathroom. So let me say, as someone who recently returned from China, that you should be prepared to one, carry your own toilet paper and two, practice your squat.

I do not mean those goofy chairless sits you see at the gym. No, toned glutes will not save you here. I mean the deep squat, where you plop your butt down as far as it can go while staying aloft and balanced on the heels. This position—in contrast to deep squatting on your toes as most Americans naturally attempt instead—is so stable that people in China can hold it for minutes and perhaps even hours ...

The debate around sexual-harassment legislation is playing out in the Maryland General Assembly, where reform advocates say leadership is loath to embrace changes.

In Maryland, legislative sessions run 90 days, from January through early April. On the final day of each session—commonly referred to by the Latin term sine die—the capital city of Annapolis lets its hair down. There is dining and dancing and parties galore as aides, lawmakers, and lobbyists celebrate having survived the season.

A few years back, at one sine die soiree hosted by a legislator, a former Annapolis aide (who requested anonymity because she remains involved in Maryland politics) took to the dance floor. “I was dancing a little bit by myself,” she recalled. “All of a sudden I hear, ‘You’re packing a little bit more than I thought back here!’ I turn around, and this legislator is dancing right behind me. I was like, ‘Ooookay. This is a little weird. I know your wife and kids.’ So I tried to subtly move away.” The legislator followed, recalled the ex-aide. And then: “He got aroused.” The young woman made a swift escape, and, she informed me, “I have not spoken to that legislator one-on-one since.”

Scholars have been sounding the alarm about data-harvesting firms for nearly a decade. The latest Cambridge Analytica scandal shows it may be too late to stop them.

On Friday night, Facebook suspended the account of Cambridge Analytica, the political-data company backed by the billionaire Robert Mercer that consulted on both the Brexit and Trump campaigns.

The action came just before The Guardian and The New York Timesdropped major reports in which the whistle-blower Christopher Wylie alleged that Cambridge Analytica had used data that an academic had allegedly improperly exfiltrated from the social network. These new stories, backed by Wylie’s account and internal documents, followed years of reporting by The Guardianand The Intercept about the possible problem.

The details could seem Byzantine. Aleksandr Kogan, then a Cambridge academic, founded a company, Global Science Research, and immediately took on a major client, Strategic Communication Laboratories, which eventually gave birth to Cambridge Analytica. (Steve Bannon, an adviser to the company and a former senior adviser to Trump, reportedly picked the name.)

The Supreme Court will consider the rights of crisis pregnancy centers, which help women “imagine what the choice of life would be like.”

Abortion is back in the Supreme Court this week. On Tuesday, the justices will hear a case on crisis pregnancy centers, the facilities established by pro-life organizations around the country to counsel women against abortion. In 2015, California passed the Reproductive FACT Act, requiring licensed clinics that provide certain services—including ultrasounds, pregnancy tests, and advice on birth control—to post information about affordable abortion and contraception services offered by the state. Unlicensed facilities that provide these services have to disclose their lack of medical certification. A network of crisis pregnancy centers, including the National Institute of Family and Life Advocates (NIFLA), sued in response, arguing that the government is violating their right to free speech by forcing them to promote abortion.